老年双相情感障碍
Bipolar disorder in old age.
作者信息
Shulman K I, Herrmann N
机构信息
Department of Psychiatry, University of Toronto, Ontario.
出版信息
Can Fam Physician. 1999 May;45:1229-37.
OBJECTIVE
To review the classification, clinical characteristics, and epidemiology of bipolar disorders in old age with a special focus on neurologic comorbidity, high mortality, and management.
QUALITY OF EVIDENCE
Most available data is gleaned from retrospective chart reviews and cohort studies. Treatment recommendations are based on evidence from younger populations and a few anecdotal case reports and series involving elderly people.
MAIN MESSAGE
While relatively rare in the community setting, mania in old age frequently leads to hospitalization. It is associated with late-onset neurologic disorders (especially cerebrovascular disease) involving the right hemisphere and orbitofrontal cortex. Prognosis is relatively poor; morbidity and mortality rates are high. Management of bipolarity includes cautious use of mood stabilizers, especially lithium and divalproex.
CONCLUSIONS
Mania in old age should trigger a careful assessment of underlying neurologic disease, especially cerebrovascular disease. Close clinical follow up is essential.
目的
回顾老年双相情感障碍的分类、临床特征及流行病学，特别关注神经共病、高死亡率及管理。
证据质量
大多数现有数据来自回顾性病历审查和队列研究。治疗建议基于年轻人群的证据以及一些涉及老年人的轶事性病例报告和系列研究。
主要信息
虽然在社区环境中相对罕见，但老年躁狂症常导致住院。它与涉及右半球和眶额皮质的迟发性神经系统疾病（尤其是脑血管疾病）有关。预后相对较差；发病率和死亡率较高。双相情感障碍的管理包括谨慎使用心境稳定剂，尤其是锂盐和丙戊酸。
结论
老年躁狂症应引发对潜在神经系统疾病，尤其是脑血管疾病的仔细评估。密切的临床随访至关重要。
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